Indicated for all patients with decreased BMD or a fragility fracture
The following are the First-line treatment to prevent fractures.
Calcium: Carbonate or citrate available; citrate can be taken with or without food & with PPI. As such, we will use calcium citrate; the goal is 1200 mg total daily intake (divided BID or TID). Advise on a diet that includes adequate amounts of total calcium intake (1000 mg/day for men 50–70; 1200 mg/day for women 51 and older and men 71 and older), incorporating dietary supplements if the diet is insufficient.
Vit D Supplementation: If low, replete to goal serum > 20 ng/ mL; Advise on vitamin D intake (800–1000 IU/day), including supplements if necessary for individuals age 50 and older.
Sunlight/ultraviolet exposure: 30 minutes per day, 5 days per week
Exercise: Recommend multicomponent exercise with regular weight-bearing, muscle-strength training, and balance training to improve agility, strength, posture, and balance; maintain or improve bone strength, and reduce the risk of falls and fractures. E.g., walking; even 1 h walking/ wk leads to a 20% reduction in risk of hip fracture compared with no activity; increased benefit with increased activity). Will refer to Physical Therapy.
Smoking cessation: Can lead to improved BMD
Decrease Caffeine Intake. Limit intake to ≤ 2.5 cups of coffee or ≤ 5 cups of tea per day
Limit EtOH: Alcohol decreases BMD & increases fall risk; > 3 drinks/ d leads to 38% increase in fx risk. Limit to ≤ 4 drinks per day for men or ≤ 2 drinks per day for women.
Fall prevention: Multifactorial fall risk assessment performed in this patient who is at increased risk falling. Will assess risk factors for falls and offer appropriate modifications (e.g., home safety assessment, balance training exercises, correction of vitamin D insufficiency, avoidance of central nervous system depressant medications, careful monitoring of antihypertensive medication, and visual correction when needed.
References
Osteoporos Int. 2014; 25(10): 2359–2381. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176573/